John E. Walker Department of Economics
School of Health Research
Fields of research interest
- Health economics
- Labor economics
- Industrial Organization
The Effect of Specialist Cost Information on Primary Care Physician Referral Patterns
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Does Government Health Insurance Reduce Job Lock and Job Push? (Under Review)
ABSTRACT: I examine the importance of cost information in the physician referral process. I partner with a group of physician medical practices -- an Independent Practice Association ("IPA'') -- to perform a field experiment testing whether providing information on the costliness of specialist physicians to primary care physicians (PCPs) alters the PCPs' referral behavior. The IPA's primary care practices were assigned randomly to treatment or control groups, and the treatment group practices were provided a list of average costs for several ophthalmologists that are affiliated with the IPA. Using data collected by the IPA, I compare differences in referral rates to the ophthalmologists of interest between the treatment and control groups. My results suggest that, during the first two months following the distribution of the cost list, the treatment group PCPs reallocated referrals towards the least expensive ophthalmology practice by 112% when the patients were the type where the costs incurred by the IPA for the referral depend on the treatment choices of the specialist. This large effect dissipated significantly, though not completely, over the following four months. For patients where specialist treatment choices have little impact on the costs the IPA incurs for referrals, I find no response to the treatment. This contrast in results suggests that PCP responses were influenced by cost reduction motives.
ABSTRACT: I study job lock and job push, the twin phenomena believed to be caused by employment-contingent health insurance (ECHI). Using variation in Medicaid eligibility among household members of male workers as a proxy for shifts in workers’ dependence on employment for health insurance, I estimate large job lock and job push effects. For married workers, Medicaid eligibility for one household member results in an increase in the likelihood of a voluntary job exit over a four-month period by approximately 34%. For job push, the transition rate into jobs with ECHI among all workers falls on average by 26%.
Does Regulation of Physicians Reduce Health Care Spending?
employer-provided health insurance constrain labor supply adjustments
to health shocks? New evidence on women diagnosed with breast cancer
ABSTRACT: The medical community argues that physician fear of legal liability increases health care spending. Theoretically, though, the effect could be positive or negative, and empirical evidence has supported both cases. Previous studies, however, have ignored the fact that physicians face risk from industry oversight groups like state-level medical licensing boards in addition to civil litigation risk. This paper addresses this omission by incorporating previously unused data on punishments by oversight groups against physicians, known as adverse actions, along with malpractice payments data to study state-level health care spending. My analysis suggests that, contrary to conventional wisdom, spending does not rise in response to increased risk. An increase in adverse actions of 16 (the year-to-year average) is associated with statistically significant, annual decreases in state spending on hospital care of approximately $22 million, and on prescription drugs of nearly $10 million. Malpractice payments are estimated to have smaller, statistically insignificant effects.
health insurance may create incentives for ill workers to remain
employed at a sufficient level (usually full-time) to maintain access to
health insurance coverage. We study employed married women, comparing
the labor supply responses to new breast cancer diagnoses of women
dependent on their own employment for health insurance with the
responses of women who are less dependent on their own employment for
health insurance, because of actual or potential access to health
insurance through their spouse’s employer. We find evidence that women
who depend on their own job for health insurance reduce their labor
supply by less after a diagnosis of breast cancer. In the estimates that
best control for unobservables associated with health insurance status,
the hours reduction for women who continue to work is 8 to 11 percent
smaller. Women’s subjective responses to questions about working more to
maintain health insurance are consistent with the conclusions from